No abstract available.

No abstract available.
Suicide, Attempted*

No abstract available.
Hospitals, General* ; Humans ; Outpatients*

OBJECTIVES: Patient insight is a very important factor in the management of schizophrenia. Manic symptoms can occasionally be identified by the patient, even in cases of schizophrenia. The aim of this study is to examine the relationship among patient insight, the psychotic and manic symptoms, and the demographic clinical variables.METHODS: Seventy-four participants (male 44, female 30) with chronic schizophrenia in community mental health facilities were evaluated according to the Korean version of the Scale to assess Unawareness of Mental Disorder (SUMD-K), the Korean version of Mood Disorder Questionnaire (K-MDQ), and the Brief Psychiatric Rating Scale (BPRS).RESULTS: The mean number of previous admissions was 3.85. The mean CGI-S score was 3.8 and a significant negative correlation (r=0.26) was shown with “awareness of mental disorder”. Thirty-five percent of subjects were K-MDQ positive (cutoff point=7 or more). Among the SUMD-K, “awareness of effect of medication” showed a significant negative correlation (r=−0.33) with the total K-MDQ score, but not with the total BPRS score. The negative correlation was more obvious in participants with negative K-MDQ (total K-MDQ score 6 or less, r=−0.31).CONCLUSION: A possible relationship was observed between these manic symptoms and patient insight. Identification of manic symptoms in schizophrenia would be considerable in a clinical setting.
Brief Psychiatric Rating Scale ; Female ; Humans ; Mental Disorders ; Mental Health ; Mood Disorders ; Schizophrenia

BACKGROUND: Progression note is a critical source in patient care. It is used to evaluate physician performance as well as the quality of clinical care. However, the majority of medical schools do not formally teach how to write progression notes. Therefore, the purpose of this research was to determine the impact of feedback education on the quality of the students' progression notes. METHODS: A static group-comparison design was used to determine the quality of progression notes written by 64 students. 31 students received feedback, but the other 33 students did not. 219 patients' progression notes were selected for this study. Progression notes were blindly reviewed by the 3 faculty members. RESULTS: Progression notes from students who received feedback showed significantly higher scores than those students who did not received feedback(p<0.05). CONCLUSIONS: Our findings suggest that feedback education in writing progression notes needs to be integrated to improve quality of the notes.
Education* ; Humans ; Patient Care ; Schools, Medical ; Students, Medical* ; Writing

PURPOSE: The aim of the study was to determine the factors associated with complicated acute cholecystitis of initial clinical findings during an emergency department (ED) visit, and to use them as a guideline for consideration of early and active surgical intervention, to improve the prognosis of acute cholecystitis. METHODS: Medical records of adult patients diagnosed and treated in the ED as acute cholecystitis were reviewed retrospectively. Clinical findings including demographic data, past medical history, symptoms, physical exam, and laboratory test results were included in the analysis. A case associated with gall bladder empyema, gangrene, perforation, hydrops, or failure of initial laparoscopic approach was defined as complicated acute cholecystitis. Factors showing significance in univariate analyses were included in binary logistic regression analysis for prediction of complicated acute cholecystitis. RESULTS: Age, sex, hypertension history, anorexia, body temperature, white blood cell count (WBC), aspartate aminotransferase, creatinine, total bilirubin, amylase, and lipase were significant in univariate analyses, and included in multivariate analysis. Age (p=0.039), male sex (p=0.004), and WBC (p=0.019) were significant in multivariate analysis. CONCLUSION: Age, sex, and initial WBC of patients diagnosed and treated in the ED as acute cholecystitis were independently associated with complicated acute cholecystitis.
Adult ; Amylases ; Anorexia ; Aspartate Aminotransferases ; Bilirubin ; Body Temperature ; Cholecystitis ; Cholecystitis, Acute* ; Creatinine ; Edema ; Emergencies* ; Emergency Service, Hospital* ; Gangrene ; Humans ; Hypertension ; Leukocyte Count ; Lipase ; Logistic Models ; Male ; Medical Records ; Multivariate Analysis ; Prognosis ; Retrospective Studies

Neovascularization of the adventitial vasa vasorum with extension into the intima of atherosclerotic lesions is frequently observed, but its pathophysiological significance is still subject to debate. Recently, leptin, the product of the Ob gene, was identified. Leptin, via activation of the endothelial receptor (Ob-R), generates a growth signal involving a tyrosine kinase-dependent intracellular pathway and promotes angiogenic processes. We hypothesized that a high concentration of leptin within vasa vasorum and plaque itself, may influence inflammatory and vascular neovascularization coupling with functional upregulation of the vascular endothelial growth factor (VEGF). Microscopic computerized tomography was utilized for the spatial distribution of vasa vasorum and intimal neovascularization from atherosclerotic human coronary arteries. Atherosclerotic coronary arteries showed a dense plexus of microvessels in the adventitia and plaque itself. Microscopic analysis from human atherosclerotic aortas revealed an increase in the intimal thickness with neovascularization. The immunoreactivity for Ob-R, VEGF and matrix metalloproteinase (MMP) increased in atherosclerotic plaque, predominantly in the endothelial lining of the intimal neovessel and macrophages/foam cells. Our observation of a prominent colocalization between Ob-R, VEGF and MMP supports this hypothesis and these factors participate in the neovascularization of atherosclerotic lesions. The present study is the first report on vascular tissue and it opens a promising perspective concerning future investigations of leptin-dependent modulation of atherogenesis and vascular neovascularization under pathophysiolgical conditions.
Adult ; Arteriosclerosis/physiopathology ; Arteriosclerosis/pathology ; Arteriosclerosis/metabolism* ; Blood Vessels/pathology ; Blood Vessels/metabolism ; Carrier Proteins/physiology ; Carrier Proteins/metabolism* ; Human ; Middle Age ; Neovascularization, Pathologic/physiopathology

OBJECTIVE: The aim of this study is to extend the indications of hysteroscopic myomectomy. METHODS: Total 304 women who had undergone hysteroscopic myomectomy between February 2001 and March 2005, were selected. Clinical characteristics, laboratory data and postoperative results were analyzed. RESULTS: Mean size of myoma is 3.5 cm, mean op. time is 47 minutes, mean deficit of distension media is 193 cc, types of distension media is URIONE(R) and normal saline, average duration of hospitalization is 4.9 days, average changes of Hb. is 1.5 g/dL, complications of op. were happended in 14 cases, that is uterine perforation (n=8), hyponatremia (n=2), pulmonary edema (n=2), delayed bleeding (n=2). CONCLUSION: The indications of hysteroscopic myomectomy can be extended. In case that patient want to preserve the uterus, deep myometrial embedded or pure intramural myoma might be resected hysteroscopically by single- or multi-step procedure. Hysteroscopic myomectomy performed at observational period may be alternative to hysterectomy in selected cases. In case of recurrence, repeat procedure may reduce the chance of hysterectomy. Intraoperative ultrasonographic guidance is an important procedure in hysteroscopic myomectomy. It lower the complications and morbidity rate.
Female ; Hemorrhage ; Hospitalization ; Humans ; Hyponatremia ; Hysterectomy ; Myoma ; Pulmonary Edema ; Recurrence ; Uterine Perforation ; Uterus

PURPOSE: Since there are no proven tumor markers that reflect the course of gastric cancer, carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are commonly used alternatives. However, the degree of progression that corresponds to an increase in these markers, and the values of these markers at different cancer stages, remains unclear. MATERIALS AND METHODS: This study enrolled 1,733 gastric cancer patients who underwent surgery and whose pre-operative CEA and CA19-9 levels were known. Survival curves and mean values of the two markers were compared according to the degree of cancer progression: serosa-unexposed (SU), serosa-exposed (SE), direct invasion (DI), localized seeding (P1), and extensive seeding (P2). RESULTS: The 5-year overall survival rates at each stage differed significantly, except between DI and P1 patients (17.1% vs. 10.5%, P=0.344). The mean CEA values in SU, SE, DI, P1, and P2 patients were 5.80, 5.48, 13.36, 8.06, and 22.82, respectively. The CA19-9 values for these patients were 49.40, 38.97, 101.67, 73.77, and 98.57, respectively. The increase in CEA in P2 patients was statistically significant (P=0.002), and the increases in CA19-9 in DI and P2 patients were significant (P=0.025, 0.007, respectively). There was a fair correlation between the two markers in P2 patients (r=0.494, P<0.001). CONCLUSIONS: CA19-9 can be used to assess DI of gastric cancer into adjacent organs. Both markers are useful for predicting the presence of extensive peritoneal seeding.
Carcinoembryonic Antigen* ; Carcinoma ; Disease Progression ; Humans ; Neoplasm Invasiveness ; Stomach Neoplasms* ; Survival Rate ; Biomarkers, Tumor

PURPOSE: To analyze the outcome of radiation therapy for patients with a metastatic carcinoma of cervical lymph nodes from an unknown primary (MUO), and identify the prognostic factors for these patients. MATERIALS AND METHODS: Between July 1981 and June 1999, 39 patients with MUO underwent radiation therapy with curative intent. Twelve patients were treated with radiation therapy alone (Group 1), 8 with neoadjuvant chemotherapy followed by radiation therapy (Group 2), and 19 with either an excision or neck dissection and postoperative radiation therapy (Group 3). There were 31 males and 8 females, with a median age of 55 years, ranging from 25 to 77 ears. The median duration of follow-up was 38 months, ranging from 3 to 249 months. RESULTS: The 5-year overall survival rate was 55%. According to the treatment modality, the 5-year disease-free survival rates of Groups 1, 2 and 3 were 48, 19 and 75%, respectively (p=0.0324). In addition to the treatment modality, the appearance of the primary site was a significant prognostic factor for disease-free survival (p=0.0085). CONCLUSION: Surgical resection and radiation therapy achieves a superior disease-free survival compared to radiation therapy alone, either with or without chemotherapy. Further investigation is needed to evaluate the role of chemotherapy in the treatment of MUO.
Disease-Free Survival ; Drug Therapy ; Ear ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Male ; Neck Dissection ; Survival Rate ; Treatment Outcome*